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Efficacy of exercise intervention as determined by the McKenzie system of mechanical diagnosis and therapy for knee osteoarthritis: a randomized controlled trial [with consumer summary]
Rosedale R, Rastogi R, May S, Chesworth BM, Filice F, Willis S, Howard J, Naudie D, Robbins SM
The Journal of Orthopaedic and Sports Physical Therapy 2014 Mar;44(3):173-181
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: Examine the efficacy of exercise intervention in patients with knee osteoarthritis (OA) directed by mechanical diagnosis and therapy (MDT) assessment. Secondarily, explore outcomes between MDT assessment-defined subgroups within the exercise group. BACKGROUND: Due to the high physical and economic burden of knee OA, the effectiveness of conservative interventions and determining which patients will respond should be investigated. METHODS: Patients (n = 180) with knee OA were randomized to exercise intervention or control groups. Within the exercise group, patients classified as having knee derangements (MDT-derangement) received MDT directional exercises and those classified as non-responders (MDT-nonresponders) were given evidence based exercises and were compared with controls receiving no exercise intervention. Pain and function were assessed at baseline, two weeks and three months using the P4 pain scale and Knee Injury and Osteoarthritis Outcome Score (KOOS-pain and KOOS-function). Two-way analysis of covariance examined treatment and time effects. Multiple comparisons were examined with mean differences with 95% confidence intervals (CI). RESULTS: Exercise intervention group had significantly (p < 0.01) improved P4 (mean difference -6, CI -8 to -3), KOOS-pain (mean difference 9, CI 5 to 13), and KOOS-function (mean difference 11, CI 7 to 15) compared with controls at two weeks. At three months, exercise intervention group had significantly (p < 0.05) improved KOOS-pain (mean difference 7, CI 3 to 11) and KOOS-function (mean difference 5, CI 1 to 9) compared to controls. CONCLUSION: Patients with knee OA, who were prescribed exercises based on a MDT assessment had superior outcomes compared to waitlist controls. MDT subgroup of knee derangement may warrant further investigation in patients with knee OA. LEVEL OF EVIDENCE: Therapy, level 1b.

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